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On the basis of experimental and clinical investigations the authors showed immunity depression in complicated forms of cholelithiasis. Thymogene appeared to be efficient for immunocorrection that permitted to lower the frequency of postoperative complications and lethality.
This study was carried out to ascertain whether, as has been suggested, the ingestion of a serum-cholesterol-lowering diet would be conducive to cholelithiasis. The prevalence of gallstones was studied in autopsied male and female patients of two mental hospitals in connection with a long-term controlled trial on prevention of coronary heart disease by means of a diet with a high polyunsaturated/saturated fatty acid ratio. The prevalence of gallstones was in men: 20/89 (equals 22.5%) on cholesterol-lowering diet and 11/44 (equals 25%) on normal diet; and in women: 151/262 (equals 42%) on cholesterol-lowering diet and 29/62 (equals 47%) on normal diet. It was concluded that in our trial the cholesterol-lowering diet was not lithogenic.
The experience with surgical treatment of cholelithiasis is presented. A method of organ-preserving operation on the gallbladder--cholecysto-extraction is presented. The operation was performed in 29 patients. The results of treatment are satisfactory.
From June 1983 to Feb. 1993, a total of 528 patients with hepatobiliary stones were surgically treated by hepatoenterostomy with a basin-typed plasty at the stump of hilar bile duct. Among them there were 220 cases suffering from cholelithiasis in the caudal lobe, with an average age of 39.1 years. Preoperative sonography, PTC, ERCP, and CT all failed to find stones in this particular location. In the 220 cases, simple caudal lobe stones accounted for 14.5%, caudal lobe stones with bile duct abnormality accounted for 46.8%, and stones with stricture of the duct for 46.4%. Surgical treatment included bile duct dilatation, cholangiotomy, and cholangioplasty and direct chilangiotomy in the caudal lobe.
An automated assessment of the results of treatment and prediction of a course of the postoperative period was performed in 218 patients with cholelithiasis by means of ES computer according to 100 parameters. Five statistic packs of the application programs (VMDR-75 version) were used. Cluster-analysis, factor analysis and a method of the main components were employed. Four most essential risk factors were distinguished, the regressive models of a postoperative period obtained. This permitted to choose the most rational method for treatment.
The authors describe their experiences with using stroke-wave lithotripsy in 102 patients with cholelithiasis. Positive results were obtained in 68% of the patients. Indications to lithotripsy are formulated. A description of specific features of the method is given.
The authors presented the results of ultrasonic investigation of 201 patients with cholelithiasis that were confirmed during surgery. Concurrent acute or chronic inflammations and hydrops of the gallbladder were found to be the commonest complications. More rare but dangerous complications were cholecystempyesis, wall destructions or paravesical abscess. Echographical symptoms of the complications mentioned were presented as well. The informative value of ultrasonic investigation turned to be rather high: the USI data coincided with operative findings in 98% of the patients.
A method for early diagnosis of cholelithiasis on a basis of the hemagglutination inhibition reaction has been suggested. A method is realized in interaction of a specific agglutinogen obtained from lithogenic bile with the human blood serum and erythrocytes of white mongrel rats. It was established that agglutinogen is a protein with a low molecular mass of 55,000-75,000. A specificity of the method is 74-100%. The method is simple in technical performance, needs no special equipment and training of personnel. High productivity (150-200 analyses can be performed by one investigator per one shift) as compared to ultrasound investigation makes it capable to compete in mass screenings.
The authors performed cholecystectomy on 9 patients either while on oral BAT, or after the termination of oral BAT. Five cases of the operation were due to hydrops, 3 cases due to obstructive cholecystitis, and one case due to contraction of the gallbladder in the absence of gallstones. Two patients underwent operation after PTCL, while one patient was operated on after ESWL. In all 12 cases serious adhesions were noticed around the gallbladder. Cholecystectomy was made complicated by the fact that in 11 cases there was cicatrized thickening of the wall of the gallbladder: one of the cases was even coupled with Mirizzi syndrome. After ESWL, the wall of the gallbladder did not thicken, however the adhesions left impressions on the hepatic duct which caused diagnostic problems. In ten cases, micro-, and in two cases mini-laparotomy was employed. The patients were discharged from hospital 24-72 hours after cholecystectomy. It is obvious that after the non operative treatment of cholelithiasis, with the preservation of the gallbladder, the reoccurrence of the gallstones is always coupled with complications which then render cholecystectomy more difficult to perform. In such cases the gallbladder is much more safely removed by employing micro- and modern mini-laparotomy.
The results of surgical treatment of 167 patients with cholelithiasis (CL) and concomitant diabetes mellitus (DM) ranging in age from 25 to 75 years and elder have been analysed. Acute form of CL was diagnosed in 101 patient, the chronic one--in 66. The tactics for conservative treatment of the patients, including insulin therapy before and after the operation, has been developed. In surgical treatment of CL and compensated DM, the preference was given to the instrumental and endoscopic methods, in decompensated DM, the radical operation was performed.
A case of a child with asymptomatic, idiopathic cholelithiasis is presented. Epidemiologic features, etiology, symptoms, diagnosis and therapy of gallstones in childhood are discussed.
The Authors present a case of cholesterinic cholelithiasis, in a patient 13 years of age. The case is interesting because the cholesterol gallstones are uncommon in childhood, with women showing a higher prevalence than men.
Cholecystectomy with surgical papillotomy is a prolonged procedure with significant morbidity and mortality. In patient stay is usually extended. Occasionally the bad general conditions and the advanced age of the patients contraindicate surgical procedures. Eventually, the drainage of the biliary ducts is inevitable. For this reason, since 1983, we are performing the endoscopic papillotomy and extraction of stones from the bile duct in patients with choledocholithiasis and cholelithiasis. Cholecystectomy was performed only in cases with real necessity. Ninety one patients, 26 men and 65 women, between 25 and 82 years, have been submitted to this procedure in our department. Cholecystectomy was performed in 52 cases after 24 to 72 hours post-papillotomy. Due to acute cholecystitis 12 patients had to be operated after a period of 2 months to 2 years. No cholecystectomy was performed in 27 patients, they are still asymptomatic. Then were no mortality related to the method.
A 5 year old patient, without any lithogenic antecedent, suffered a trauma, resulting in a shrunken fracture of the left parietal bone, and a splenic parenchymal hematoma. A hemoperitoneum developed at the 3rd postoperation day, with an overall blood loss of 15% of the total blood volume. At the 6th day a well formed biliary calculi was detected in the gallbladder. As the patient remain asymptomatic related to his cholelithiasis, an ultrasound follow-up was instituted. At 3 month postinjury all biliary stones dissolved completely. In this report, the etiopathogenic factors responsible of stone formation in the biliary tree, and current therapeutic recommendations are reviewed.
The management of cholelithiasis is usually straightforward, but there are a few special situations and questions which arise repeatedly. This paper deals with management of patients with asymptomatic stones, diabetic patients with stones, the relationships between stones and cancer, and patients without stones but who have typical pain. It also considers certain surgical topics of interest to primary care specialists, including that of safety of laparoscopic surgery, pain after surgery, and the role of incidental cholecystectomy.
The levels of cholesterol, calcium and bilirubin were determined in the serum and gall stones in 47 cases with cholelithiasis. The mixed stones were observed in 87.5%, high cholesterol stone in 8.5% and high bilirubin stones in 4.2%. Serum and stone cholesterol levels were inversely proportional and the bilirubin levels were directly proportional to each other.
Cholelithiasis in homozygous sickle cell disease is a common complication. Mean prevalence rate recorded is 27.4% with a greater frequency in the second part of life. It is a peculiar lithiasis, made of pigmentary stones either purs or duals, caused by hypersaturation of indirect bilirubin. Systematic detection of such a lithiasis by echography is part of monitoring homozygous drepanocytic.
A review of 132 cirrhotic patients with cholelithiasis was carried out. Of the 87 patients who underwent definitive surgical procedures for gallstones, patients of Child's A grade had less operative blood loss, blood transfusion and shorter hospital stay than those of B and C grades. No mortality in cirrhotic patients with Child's A and B grade was found in both emergency and elective surgery. Emergency operation in patients with Child's C grade resulted in more operative blood loss and requirement than elective surgery. Patients in this grade had also a higher morbidity rate and four deaths ensued. Of the 83 survivals after definitive procedures, 78 patients (93.9%) were still alive in the following 62.8 months without any biliary tract symptoms. Of patients who survived after cholecystolithotomy, 6 patients (33.3%) had recurrent stones in the same follow-up period. Therefore, we recommend that definitive biliary surgery be selectively carried out in cirrhotic patients in Child's A and B grade. However, a conservative approach is more suitable in Child's C patients in emergency conditions and definitive procedures should be considered when their liver function improves.